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| 題名: | Tw-DRGs支付制度解釋現行醫療費用點數之能力---- 以脊椎融合術為例
The ability of the Taiwan Diagnosis Related Groups (Tw-DRGs) systems to explain in the costs --using spinal fusion as example |
| 作者: | 曾泓瑞;Hung-Jui Tseng |
| 貢獻者: | 生物統計研究所碩士班 |
| 關鍵詞: | 診斷關係症候群;台灣版診斷關係症候群;DRG;Tw-DRG |
| 日期: | 2014-07-25 |
| 上傳時間: | 2014-10-02 09:41:54 (UTC+8) |
| 出版者: | 中國醫藥大學 |
| 摘要: | 目標：脊椎融合術之DRGs (diagnosis-related groups)為第二階段將推行之DRG支付裡的其中ㄧ個術式，但因脊椎融合術所使用的特材可能對醫療費用產生極大的變異且個案較多，故本研究將探討目前台灣版DRGs中的有關脊椎融合術之DRGs對於醫療費用之解釋力，並給予適當的修正建議。
方法：資料來源為財團法人佛教慈濟醫院四家區域級已上醫院(台中；台北；大林；花蓮)之申報資料庫，研究對象需於2011年1月~2013年10月出院之個案，此個案入院執行脊椎融合手術(Spinal fusion)，住院ICD-9 手術碼：81.0X脊椎融合術且有申報脊椎融合術之醫令碼。
結果：我們利用三個 linear models with fixed effects分別去探討各模型(Model)對於解釋log(醫療費用點數)變異之能力，並決定是否針對Tw-DRGs給予修正，第一個模型(MD)：只含 DRGs變項；第二個模型(MP)：只含患者本身特徵變項；第三個模型(MF)：包含以上兩組之變項，再藉由hospital fixed effects去了解各家醫院對於醫療費用點數之影響，此影響為不隨DRGs與病患特徵改變而改變，並藉此測量各家醫院之管理效能。
結論：由MD相對MF的解釋力與MP相對MF的解釋力之比較，我們現行脊椎融合手術之DRGs確實有修正的必要。原本DRG496、DRG497、DRG498對於log(醫療費用點數)之 :0.2008，中央健康保險署2014/07/01公告草案修正DRG之 : 0.2208，但第二類材變異較大，故本研究建議：DRG496依有無『有效CC』進行拆組；DRG497與DRG498先依『手術部位』進行拆組，再依『有無使用第二類特材』進行拆組，之後DRG497再依『有效CC數量≧2』拆組，而DRG498再依『手術節數』拆組，拆組後整體為 :0.3937，如此藉由DRG之修正，對於醫療費用點數變異之解釋能力可提高96%。
Purpose:
In the second stage Tw-DRG(TaiwanDiagnosis Related Groups) payment system, Health Insurance Department will promote Diagnosis-related groups(DRGs) of spinal fusion as a DRG payment system. But the special materials used in spinal fusion surgery of resource requirements might vary among patients ,and they are more cases in the second stage Tw-DRG payment system. Therefore, this study test the performance of model in explaining variation in the (log of) cost of the inpatient stay ,and improve the explanatory power of existing DRGs for spinal fusion patients.
Method:
From January 2011 to October 2013,we collected samples of patient discharged with ICD 9 CM procedure code:81.0X.(spinal fusion). ,and patients also to paid by the surgery order codes at the same time in the database of Tzu Chi Hospital (Taichung; Taipei; Dalin; Hualien).
Result:
We use three linear models with fixed effects in explaining variation in the log(cost) of the inpatient stay then revision Tw-DRGs system. The first model: the model with DRGs only .The second model: Only patient characteristics variables . The third model: the full specification model. Then by hospital fixed effects to represent the impact of the cost of each hospital,this hospital fixed effects does not change with the change of patients characteristics and DRGs.
Conclusion:
Comparison of MD and MF in the relative explanatory power,and MP and MF in the relative explanatory power.Results obtained that DRGs system for spinal fusion require revisions.
Originally DRG496 DRG497 DRG498,the explanatory power of DRG was 0.2008.
The latest version of the Department of National Health Insurance Announcement of National Health Insurance of the DRG on July 1, 2014,the explanatory power of DRG will be 0.2208. However, a large variation in the second class of materials. Therefore, this study suggests, DRG496 based on Complication and/or Comorbidity variable to be divided into two groups;DRG497 and DRG498 were grouped according to body part, then DRG497 then grouped according to the number of Complication and/or Comorbidity, and then DRG498 then grouped according to number of vertebral.
After regrouping overall :0.3937. Then grouped by DRG , the ability to explain the variation in cost can be increased to 96%. |
| 顯示於類別: | [生物統計研究所] 博碩士論文
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